A prospective study of pre-illness diet in newly diagnosed patients with Crohn's disease.

BACKGROUND: Environmental factors, including diet, seem to participate in the etiology of inflammatory bowel disease. The kind of dietetic habits before the appearance of the illness in patients with Crohn's disease (CD) has not been studied extensively. AIM: To prospectively assess the kind of food consumption in patients with CD exactly at the time of diagnosis and to identify dietary constituents as risk factors for development of CD. PATIENTS - METHODS: Twenty eight patients with a newly established diagnosis of CD (2-4 weeks), (12 men and 16 women), 30 patients with previously (between 2 - 11 years) established diagnosis of CD (14 men and 16 women) and 38 age- and sex-matched healthy controls (16 men and 22 women) were included in the study. Dietary intake was assessed by means of special questionnaire. RESULTS: Comparisons between controls and newly diagnosed patients showed that increased consumption of milk and yogurt (P = 0.042), fruits (P = 0.0001), citrus (P = 0.0001), vegetables (P = 0.0001), carrots (P = 0.0001), legumes (P = 0.036), fish and selfish (P = 0.001), honey (P = 0.003), and nuts (P = 0.038), was associated with decreased risk for CD. On the other hand, significantly increased intake of fat (P = 0.041), olive oil (P = 0.038), margarine (P = 0.038), sugar (P = 0.02), alcohol drinks (P = 0.009), fried food (P = 0.0001), and pasta (P = 0.0001), was noticed on recently diagnosed patients in comparison with the healthy control group. On logistic regression analysis foods remaining statistically significant were: margarine, pasta, fried foods, fat, olives, sugar (increased risk), and yogurt, honey, fruits, nuts, fish, and citrus fruits (decreased risk). Newly diagnosed patients were significantly overweighed (64%) compared to healthy people (26%) and old patients (7%). CONCLUSION: Significant differences in many kinds of food between newly diagnosed patients with CD, patients with established CD and normal people certainly exist. Our results suggest that specific dietary patterns could be associated with higher or lower risks for CD in adults. However, whether these dietary factors are important for the development of CD or modulate the effect of other environmental factors is unknown.

Similar response to adalimumab in patients with active Crohn's disease either naive to biologic agents or with prior loss of response or intolerance to infliximab.

UNLABELLED: The aim of this study was to investigate the efficacy of adalimumab, in patients with moderately active Crohn's disease (CD), either naive to biologic agents or with prior loss of response or intolerance to infliximab. MATERIAL AND METHOD: A total number of 30 patients with moderately active CD (14 men, 16 women, aged 38.5 +/- 14.4 yr) either naive to biologic agent treatment (19 pts (65%)) or with loss of response or intolerance to infliximab (11 pts (35%)), were enrolled to 4-wk trial with treatment with subcutaneous adalimumab 160 mg injection at week 0, 80 mg at week 2 and then 40 mg every other week. Outcome measures included the ability to tolerate adalimumab and clinical remission (defined as a CDAI score < or =150 points) and clinical response (defined as a decrease in the CDAI) > or =70 points). Eleven patients (37%) were smokers, 5(16%) ex-smokers and 14 (47%) non-smokers. Five patients (16%) had a positive family history for IBD. Duration of disease was 10.7 +/- 8.1 yr. Coexistence of extraintestinal manifestations was noticed in 12 (40%) patients. Vienna Classification of CD was A1=24 (80%), A2=6 (20%), L1=8 (26.7%), L2=6 (20%), L3=15 (50%), L4=1 (3.3%), B1=15 (50%), B2=5 (16.7%), B3=10 (33.3%). RESULTS: Remission was observed in 19 (63.3%) and clinical response in 9 (30%) patients. Two patients (6.7%) showed no response. No significant differences between patients with loss of response or intolerance to infliximab and the group of naive patients were noticed. Comparison between smokers and non smokers revealed significant difference in the response rate in favour of non-smokers (P < 0.002). A trend (P = 0.064) towards a significant difference in the response rate of the group of smokers according to the number of cigarettes smoked per day was observed. Patients with short duration of disease (<10 yr) had significantly better response compared to the group of patients with long (>10 yr) duration of disease. Similarly, patients with extraintestinal manifestations showed significantly better response (P = 0.044). None of the patients in both groups experienced acute or delayed hypersensitivity reactions during treatment with adalimumab. CONCLUSION: Adalimumab is well tolerated and appears to be a beneficial option for patients with CD who have not previously treated with biologic agents or have lost their response to, or cannot tolerate infliximab, with non-smokers, patients with short duration of CD, and patients with extraintestinal manifestations having a better clinical response.

Risk factors for colorectal polyps: findings from a Greek case-control study.

UNLABELLED: There is a body of evidence showing that several lifestyle and dietary factors are associated with colorectal polyps' formation; however, the magnitude of this association in diverse populations remains unclear. The aim of this study was to investigate this association in a Greek sample. MATERIAL AND METHOD: The study comprised of 52 subjects with histologically confirmed advanced colorectal polyps and 52 healthy controls. Data concerning lifestyle and dietary factors were collected using a validated questionnaire. Logistic regression analysis was used to estimate odds ratios and 95% confidence intervals after adjustment for potential confounders. RESULTS: Physical activity level (95% CI 0.032-0.953, P = 0.044) and consumption of yoghurt (95% CI 0.969-0.996, P = 0.024), cheese (95% CI 0.932-0.996, P = 0.030), fish (95% CI 0.782-0.964, P = 0.008), vegetables (95% CI 0.965-0.998, P = 0.029), and garlic (95% CI 0.005-0.671, P = 0.022) were inversely associated with colorectal polyps. Increasing age (95% CI 1.005-1.231, P = 0.039) and central obesity (95% CI 1.001-1.019, P = 0.025) were strongly associated with their presence. CONCLUSION: Our study indicates that a cluster of modifiable risk factors have significant impact on colorectal polyps' occurrence in Greek population.

Acute idiopathic pancreatitis preceding diagnosis of Crohn's disease. Description of three cases.

UNLABELLED: Acute idiopathic pancreatitis seems to represent a rare extraintestinal manifestation of Crohn's disease usually appearing after the establishment of diagnosis of the intestinal disorder. The aim of this study was to describe the clinicoepidemiological characteristics and clinical course of three patients with Crohn's disease who developed acute idiopathic pancreatitis years before the establishment of diagnosis intestinal disease. DESCRIPTION OF CASES: All patients were suffering from Crohn's disease. In all patients, an extensive work-up aiming to identify an etiological factor involved in the pathogenesis of acute pancreatitis was negative. The main clinical characteristics of the patients were the young age, the mild or moderate degree of severity of pancreatitis, and the concurrent involvement of small and large bowel from Crohn's disease in two of them. There was no preference for either male or female sex. The course of pancreatitis was favorable in all patients. During the follow-up period, ranging from 2 to 8 years, no exacerbation of pancreatitis was noticed. CONCLUSION: This case-series suggests that acute idiopathic pancreatitis could precede diagnosis of Crohn's disease. Clinicians must bear in mind the possibility of the existence of Crohn's disease when they are confronting a young patient with clinical and laboratory features of acute idiopathic pancreatitis.

Coexistence of medullary sponge kidney and ulcerative colitis in the same patient: long-term follow-up.

We describe a female patient with ulcerative colitis since the age of 17, who was accidentally diagnosed as having medullary sponge kidney 3 years after the establishment of diagnosis of inflammatory bowel disease. The diagnosis of renal disease was based on the typical appearance of both kidneys on abdominal ultrasound examination and on IV pyelography findings. All other well-known causes of medullary sponge kidney were excluded on the basis of the relevant laboratory investigation. So far, the patient experienced only one episode of urinary infection but no renal colic. Since the time of diagnosis of ulcerative colitis her renal function tests are perfectly normal. She is under maintenance treatment with mesalazine. The benign nature of the situation was explained to her. She was advised to drink at least one and a half litter of water daily, in order to reduce the risk of nephrolithiasis. The combination of the two disorders in our patient is probably the result of a chance. However, taking into account the potentially dangerous long-term results of medullary sponge kidney, we suggest that patients with ulcerative colitis must have a careful ultrasound examination of both kidneys at least at the time of diagnosis of the bowel disease, in order to exclude the possibility of medullary sponge kidney, as conservative measures could result in avoidance of potentially dangerous complications, such as renal stones and urinary infections.

Pregnancy and inflammatory bowel disease: a prospective case-control study.

OBJECTIVE: Taking into account the relative confusion in the literature concerning the influence of pregnancy on the underlying inflammatory bowel disease (IBD) and vice versa, as well as the influence of drugs on the foetus and the gestation itself, we performed this prospective study, in order to further elucidate this interesting topic. PATIENTS AND METHODS: Prospective follow-up study of 9 pregnant women with previously established IBD, 4 with ulcerative colitis (UC) and 5 with Crohn's disease (CD). Results were compared to those of 9 non-pregnant women with IBD with similar clinico-demographic characteristics (disease control group), and 18 healthy pregnancy women (healthy control group). RESULTS: (a) Patients with IBD and gestation vs. healthy control group: Significantly impaired body weight in newborns from IBD mothers compared to healthy women (2530 +/- 961 g vs. 3242 +/- 582 g, P = 0.035) was found. Significantly more cases of therapeutic or spontaneous abortion and premature delivery in pregnant women with IBD compared to healthy pregnant women [5/ 9(56.6%) vs 1/18 (5.6%), P = 0.008] were also noticed. Concerning drug consumption, it was noticed that azathioprine was taken regularly in one case of spontaneous abortion and in one case of premature delivery. No significant differences concerning other parameters such as smoking habit and death of foetus were observed. (b) Patients with IBD and gestation vs. patients with IBD without gestation: No significant differences in the history of various parameters of the disease (number of operations, presence of fistulas), previous gestations, and course of the disease during the period of gestation were found. (c) Course of the disease six months after delivery: No significant differences between patients with IBD and pregnancy and disease control group were noticed. CONCLUSION: It is concluded that gestation in women with IBD is accompanied by some unwanted events such as premature delivery, therapeutic or spontaneous abortion, and reduced newborn body weight. Clinicians must bear in mind the possibility of the appearance of some unwanted events in pregnant women with IBD during their gestation.

[Seizures during the treatment with interferon for chronic C hepatitis]. / Crise comitiale au cours d'un traitement par interféron alpha, aux faibles doses, dans un cas d'hépatite chronique virale C.

Interferon alpha (IFN-alpha) is a well-established first-line treatment for chronic viral hepatitis. Side effects of IFN-alpha therapy are common but generally mild and self-limited. Generalized seizures during IFN-alpha therapy are very uncommon and are present in clinical isolated cases and usually in association with high doses of IFN-alpha. In our case a female of 39 years old, seizures have occurred at low doses of IFN-alpha used as therapy for chronic C viral hepatitis. As it comes to our knowledge, till now, there were published only 4 cases of generalized seizures that occurred during treatment with IFN-alpha for chronic C viral hepatitis. The physiopathology of this complication is unknown. Generalized seizures can be reasonable due to IFN-alpha therapy, as long as the patient didn't have any seizure history, or other factors, which can develop seizures. Neurological examination, EEG and brain scan were normal. The recurrence of these seizures was absent stopping IFN-alpha therapy without any other seizure treatment.

Helicobacter pylori infection, nonsteroidal anti-inflammatory drugs, and gastroduodenal pathology: current status.

Non-steroidal anti-inflammatory drugs (NSAIDs) are now widely used medicines and their relationship with gastroduodenal injury is well established. The overall risk for serious gastrointestinal side effects in patients taking NSAIDs is three times greater than that of control groups and this risk rises to more than five times in elderly patients. Moreover, the risk of gastrointestinal surgery is ten times greater in elderly patients taking NSAIDs than in controls. Therapeutic aspects like the necessity of eradication of Helicobacter pylori (H. pylori) in order to reduce the gastroduodenal risks for NSAIDs users, the indication for eradication of H.pylori of those with past history of peptic ulcer and require NSAID therapy, the role of eradication when the NSAIDs are used in association with misoprostol.